NEW ORLEANSIn women with locally advanced cervical cancer, smoking is an
independent risk factor for a significantly worse outcome, a new study from
the Gynecologic Oncology Group (GOG) has shown.
Smoking has previously been shown to be an independent risk factor for
squamous cell carcinoma of the cervix. About 50% of North American women who
develop cervical cancer, in fact, are smokers. The present study takes this
finding a step further, showing that smoking also affects survival.
In GOG 165, reported at the 34th Annual Meeting of the Society for
Gynecologic Oncologists (abstract 71), 315 patients with stage IIb, IIIb, and
IVa cervical cancer were randomized to two different treatment arms from 1977
to 2000 and followed for a median of 31.5 months. GOG 165 compared the
effectiveness of cisplatin (Platinol)-based chemoradia-tion vs chemoradiation
using prolonged venous infusion of fluorouracil (5-FU). The duration of
radiotherapy was similar for the two groups, and gastrointestinal toxicity
was also similar.
Prior to beginning chemoradiation therapy, patients completed a
questionnaire pertaining to past and current smoking behavior. Subjects were
considered smokers if they were currently smoking one or more cigarettes per
week. Smoking status was confirmed by urinary cotinine analysis, with a level
of 100 ng/mL or greater being considered indicative of smoking. Self-reported
smoking and urinary cotinine results had 94.4% agreement. Of the 315
patients, 42% were current smokers. Current smoking status was associated
with younger age, higher stage of disease, and squamous histology.
The study found a 44% increased risk of disease progression and a 59%
increase in the relative risk of death among current smokers, reported Steven
E. Waggoner, MD, of Case Western Reserve University, Cleveland.